Imagine going to a doctor’s appointment and not knowing how to get to the office, not understanding the complicated health care system and not speaking the language of the health care provider you were seeing.
Well, this can be the case for many new refugees settling in the US, and one Columbia agency, Refugee and Immigration Services, has partnered with senior nursing students from the Sinclair School of Nursing for the past few years, to help bridge those gaps. The Health Navigation Program helps new refugees learn how to efficiently and effectively navigate the health care system.
Over the course of the 2014 fiscal year, nearly 1,400 refugees were resettled in Missouri. Upon arrival, these refugees are given services to help them survive and thrive in the United States – things like food stamps, coverage for medical services and employability assistance.
But while medical services are covered for refugees, there are still many challenges facing new refugees when it comes to health like language barriers, lack of transportation, financial limitations, unfamiliarity with the health care system and low levels of health literacy.
According to the Office of Refugee Resettlement, the ability to access the healthcare system is especially important for refugees as they face additional health issues such as infectious diseases like tuberculosis, chronic diseases like diabetes and hypertension, and post-traumatic stress disorder and depression.
The two senior nursing students paired with Refugee and Immigration Services, this semester, are Stone Chen and Emilie Winn. They are working with the agency for their community health class – where the goal is for them to learn about public health by doing public health.
Chen and Winn are responsible for organizing aspects of the Health Navigation Program.. They learned about the barriers to care for refugees, recruited volunteers, scheduled health care appointments and worked to develop new ways to engage and educate refugees about health.
Winn said her experiences through the program have already helped her “realize that everyone comes from a different place and has their own barriers to deal with like language barriers and cultural barriers.”
Chen said he understands, from personal experience, what the refugees are going through.
“I'm an immigrant myself. I moved to America when I was 12. I understand some of the frustrations that a newcomer might have,” Chen said. “When I first came over here, I didn’t speak English at all. I didn’t understand very much of the culture. So, I'm excited just to show people that will potentially have the same struggles and I'm able to help them in that way because I can in some sense relate to them.”
"Everyone comes from a different place and has their own barriers to deal with like language barriers and cultural barriers."
I met the two when they were headed to meet Laldin Liana, a recent Burmese refugee, who had a doctor's appointment in October. Both stood back and let Liana take the lead once at the doctor's office - he greeted the receptionist, handed over his insurance card and paid his co-pay.
This is because the Health Navigation Program is to help refugees learn how to navigate the healthcare system – on their own.
“I think one of the big think part of our program is we're trying to promote self-sufficiency. And also help them understand our health care system,” Chen said.
Megan Gore, the new health coordinator for Refugee and Immigration Services, said refugees receive medical coverage upon arrival. According to the Office of Refugee Resettlement, these refugees then receive medical coverage for their first eight months.
So, through the Health Navigation Program, the nursing students, other student volunteers or Refugee and Immigration Services case workers help the refugees schedule health appointments. Then they met the individual at their home and either walk, drive or ride the bus to the appointment alongside the refugee.
Chen explained what happens once the refugee and volunteer arrive at the doctor’s office.
“They [refugees] are going to go to various health appointments and we're going to guide them,” Chen said. “So, maybe the first time we’ll help them basically talk to the people at the front desk and make sure they have interpreters. But the more appointments they go to, we’re going to let them speak to the front desk, we're going to let them call the interpreters. We'll be there to guide them, watch them.”
The volunteer then evaluates the level of self-sufficiency the refugee has reached. They use a grading scale, where red means the navigator must do everything for the refugee, yellow means the refugee can handle most of the responsibility and green means the refugee can do it all on their own.
John Marrin was one of the nursing students who worked with Refugee and Immigration Services last spring. He said it’s important to not take too much control.
“We're not there to take the place of the existing resources,” Marrin said. “We really just want to advocate and make sure they're being used.”
"The best way to learn is you do it yourself."
Learning how to use these available resources makes it is so the refugees can eventually feel comfortable and confident going to appointments on their own.
“The best way to learn is you do it yourself,” Chen said.
According to the Spring 2015 Annual Report, prepared by Marrin and his partner, Refugee and Immigration Services has helped resettle nearly 1,500 refugees since 2005. And in 2014, the case managers and nursing student volunteers helped set up 132 health appointments. Nursing students covered about 10 percent of these appointments.
But Chen said it’s more than just appointments.
“Our volunteers can schedule a time meeting with the refugees where they live and walk with them to the bus stops and basically show them, guide them how the bus system works because most of them don’t have a license and don’t have a car,” Chen said.
Emilie Winn said the program continues to grow. Nursing students helped establish the partnership with Refugee and Immigration Services and helped create the Health Navigation Program. Next, a different pair of students worked to train some medical professionals in cultural competency.
"They [refugees] are going to go to various health appointments and we're going to guide them."
Then last spring, Marrin and his partner wrote the Spring 2015 Annual Report and organized health orientation workshops, and this semester, Chen and Winn are hoping to take it another step further.
“Stone and I recently have been trying to focus on resources in the community, like the Farmers' Market,” Winn said. “And also educating them [refugees] on the benefits of physical exercise and eating healthy.”
Chen added they are putting together a pamphlet of information and resources, and are hoping to organize events where refugees are walked from their homes to the Farmers’ Market and shown some of the many trails and parks Columbia has to offer.
